Gestion d’un cluster de COVID-19 : expérience d’un CH

Introduction

Dans le contexte d’infections à COVID-19 en Chine depuis décembre 2019, nous avons créé une procédure de prélèvement et de prise en charge des cas possibles. La nuit du 6 au 7 février, le SAMU déclenche une alerte pour 2 patients, en contact avec un cas confirmé COVID-19 dans les 14 jours précédents et consultant pour une infection respiratoire haute.

Matériels et méthodes

Nous décrivons la gestion de l’alerte, la création d’une cellule de crise locale pluridisciplinaire et les interactions avec les différentes instances régionales et nationales.

Résultats

En l’absence de signes de gravité, les 2 patients rentrent à domicile pour confinement avec 11 autres personnes exposées. En concertation avec l’ARS, des prélèvements pour tous, symptomatiques ou non, sont réalisés au domicile le 7 février par un médecin et une IDE d’infectiologie. Cinq sont positifs à COVID-19 le soir même. Ceci entraîne la création d’une cellule de crise locale composée des directions, de l’unité d’hygiène, d’infectiologues, du SAMU, des urgences, de microbiologistes et de pédiatres, en lien avec les instances territoriales, régionales et nationales lors de conférences téléphoniques pluriquotidiennes. Les cas confirmés sont hospitalisés dans 3 CHU proches pour maintenir les capacités d’accueil dans les 2 CH de proximité. Le contact tracing est assuré par les ARS territoriale et régionale et la DGS (pour l’étranger). Les principales actions de la cellule de crise locale sont la mise en place :

– d’une stratégie progressive, raisonnée, adaptable à l’évolution de la situation sans céder à la panique ;

– d’un circuit extérieur dédié pour les urgences (pour afflux éventuel de patients) ;

– de secteurs d’hospitalisation pour cohorting des cas possibles ou confirmés ;

– d’une campagne de prélèvements par des binômes infectiologues/paramédicaux dans le village où résident les cas confirmés le premier jour (91 faits, tous négatifs) puis dans le CH les jours suivants, pour les contacts à haut risque symptomatiques.

Les points forts de cette organisation ont été la réactivité et la mobilisation générale des professionnels, la collaboration fluide avec l’ARS territoriale et la complémentarité médico-administrative.

Les principales difficultés ressenties étaient en lien avec :

– le nombre élevé de contacts, gérés par 3 instances différentes ;

– le manque de transmission d’informations en temps réel aux équipes locales ;

– l’inadéquation entre les impératifs du terrain et les consignes et concertations nécessaires aux niveaux supérieurs.

Conclusion

Cette expérience permet de souligner les forces et les faiblesses de la gestion locale d’un cluster de COVID-19. Une réunion de débriefing avec les différents acteurs sera pertinente afin d’améliorer le dispositif pour des situations semblables à l’avenir.

Consequences of Undervaccination - Measles Outbreak, New York City, 2018-2019

BACKGROUND

Measles was declared eliminated in the United States in 2000, but the risk of outbreaks owing to international importations remains. An outbreak of measles in New York City began when one unvaccinated child returned home from Israel with measles; onset of rash occurred on September 30, 2018, 9 days after the child returned home.

METHODS

We investigated suspected cases of measles by conducting interviews, reviewing medical and immunization records, identifying exposed persons, and performing diagnostic testing. Measles-mumps-rubella (MMR) vaccine (given as either MMR or measles-mumps-rubella-varicella vaccine and collectively referred to as MMR vaccine) uptake was monitored with the use of the Citywide Immunization Registry. The total direct cost to the New York City Department of Health and Mental Hygiene was calculated.

RESULTS

A total of 649 cases of measles were confirmed, with onsets of rash occurring between September 30, 2018, and July 15, 2019. A majority of the patients (93.4%) were part of the Orthodox Jewish community, and 473 of the patients (72.9%) resided in the Williamsburg area of Brooklyn, New York. The median age was 3 years; 81.2% of the patients were 18 years of age or younger, and 85.8% of the patients with a known vaccination history were unvaccinated. Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. As a result of efforts to promote vaccination, the percentage of children in Williamsburg who received at least one dose of MMR vaccine increased from 79.5% to 91.1% among children 12 to 59 months of age. As of September 9, 2019, a total of 559 staff members at the Department of Health and Mental Hygiene (7% of the agency) had been involved in the measles response. The cost of the Department of Health and Mental Hygiene response was $8.4 million.

CONCLUSIONS

Importation of measles and vaccination delays among young children led to an outbreak of measles in New York City. The outbreak response was resource intensive and caused serious illness, particularly among unvaccinated children.

Metal-free aerobic C–H oxidation of cyclic enones

A metal-free procedure is described for the aerobic and complete C–H methylene oxidation of Hajos–Parrish enones to versatile dihydroindenediones.

Abstract P5-10-06: A functional role for miR-150 in breast cancer

Background: During mammary gland development, massive coordinated changes in protein expression govern the progression through pregnancy to lactation and involution. These dramatic changes are likely regulated in part at the translational level by changes in microRNAs (miRNAs). We profiled miRNA expression in mammary epithelial cells (MECs) isolated from mice at pregnancy day 14 (P14) or lactation day 2 (L2) and found that miR-150 is the most significantly downregulated miRNA between pregnancy and lactation. Interestingly, miR-150 was recently discovered to be decreased in mouse mammary tumors compared to normal mammary tissue in numerous transgenic models. However, a causal role for miR-150 has yet to be studied in human breast cancer and little is known about its functional role and relevant targets in the normal breast or breast cancer.

Hypothesis: We hypothesized that miR-150 may be a tumor suppressor whose loss in breast cancer cells is an important event that allows for expression of multiple pro-tumorigenic genes.

Methods: miR-150 levels in human breast cancers were evaluated in specimens of both ER+ and triple-negative breast cancer (TNBC) as compared to adjacent, non-involved normal breast epithelium by in situ hybridization. miR-150 levels were also measured by qRT-PCR in cell lines representative of multiple breast cancer subtypes. We stably restored miR-150 in TNBC cell lines by lentiviral infection and evaluated its effects on clonogenicity, growth in 3D culture, migration/invasion, and tumorigenicity. Expression of predicted miR-150 targets was assessed by immunoblot. Crossing of miR-150fl/fl mice with BLG-Cre or MMTV/NIC transgenic mice will be utilized to determine the effects of MEC-specific loss of this miRNA on mammary tumorigenesis.

Results: In clinical samples, in situ hybridization reveals that miR-150 levels are lower in both ER+ and TNBC tumor specimens compared to adjacent normal epithelium, with triple-negative tumors having the lowest expression. All breast cancer cell lines tested also have low miR-150 expression as compared to normal mammary epithelial tissue, with TNBC cell lines expressing the lowest levels. Exogenous expression of miR-150 in breast cancer cell lines caused a dramatic decrease in migration and invasion in vitro, and we are testing predicted miR-150 targets for their role in this phenotype. Experiments with transgenic models will determine if loss of miR-150 in mammary epithelial cells in the MMTV/NIC mouse model results in decreased latency or increased tumor formation and metastasis, or if miR-150 loss during pregnancy results in alterations in lactation, hyperplasia, or tumor formation.

Conclusions: TNBC specimens and cell lines have the lowest expression of miR-150, though decreased miR-150 expression compared to normal mammary epithelium is a common feature of breast cancers regardless of subtype. miR-150 expression dramatically inhibits breast cancer cell migration and invasion in vitro, and ongoing experiments will determine the relevant target genes.

Supported by Susan G. Komen Grant KG090415 and NIH NICHD P01 PAR-10-245 (Project 3) to JKR

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-10-06.

The nucleus accumbens 5-HTR₄-CART pathway ties anorexia to hyperactivity

In mental diseases, the brain does not systematically adjust motor activity to feeding. Probably, the most outlined example is the association between hyperactivity and anorexia in Anorexia nervosa. The neural underpinnings of this 'paradox', however, are poorly elucidated. Although anorexia and hyperactivity prevail over self-preservation, both symptoms rarely exist independently, suggesting commonalities in neural pathways, most likely in the reward system. We previously discovered an addictive molecular facet of anorexia, involving production, in the nucleus accumbens (NAc), of the same transcripts stimulated in response to cocaine and amphetamine (CART) upon stimulation of the 5-HT(4) receptors (5-HTR(4)) or MDMA (ecstasy). Here, we tested whether this pathway predisposes not only to anorexia but also to hyperactivity. Following food restriction, mice are expected to overeat. However, selecting hyperactive and addiction-related animal models, we observed that mice lacking 5-HTR(1B) self-imposed food restriction after deprivation and still displayed anorexia and hyperactivity after ecstasy. Decryption of the mechanisms showed a gain-of-function of 5-HTR(4) in the absence of 5-HTR(1B), associated with CART surplus in the NAc and not in other brain areas. NAc-5-HTR(4) overexpression upregulated NAc-CART, provoked anorexia and hyperactivity. NAc-5-HTR(4) knockdown or blockade reduced ecstasy-induced hyperactivity. Finally, NAc-CART knockdown suppressed hyperactivity upon stimulation of the NAc-5-HTR(4). Additionally, inactivating NAc-5-HTR(4) suppressed ecstasy's preference, strengthening the rewarding facet of anorexia. In conclusion, the NAc-5-HTR(4)/CART pathway establishes a 'tight-junction' between anorexia and hyperactivity, suggesting the existence of a primary functional unit susceptible to limit overeating associated with resting following homeostasis rules.

Toward the management of inflammation: recent developments of mPGES-1 inhibitors

For decades, the struggle against inflammation and related disorders has constituted an important field in medical practice, with strategies mainly aimed at inhibiting compounds produced through the arachidonic acid pathway. Thus, specific COX-2 inhibitors or "coxibs", were recently designed, that play an increasing but controversial role in reducing inflammatory phenomenon. Lately, several patents have been generated which target the specific inhibition of the microsomal Prostanglandin E synthase-1 (mPGES-1). This enzyme, which was cloned and characterized at the end of the nineties, catalyzes under inflammatory stimuli the last step of PGE2 synthesis. A corpus of data is now available illustrating the pivotal role played by this enzyme in numerous symptoms linked to inflammation such as fever, anorexia or pain. The present review highlights the current state of knowledge of the involvement of mPGES-1 in sickness behaviour and in other inflammation-related disorders and summarizes the recent patents related to mPGES-1 and its specific inhibition.

Expression of leptin receptor by glial cells of the nucleus tractus solitarius: possible involvement in energy homeostasis

Leptin, an adipocyte-derived hormone, regulates food intake and body weight by acting principally on the hypothalamus, which displays the highest expression of leptin receptor (Ob-R). Nevertheless, other regions of the brain express Ob-R and constitute leptin's target sites. The dorsal vagal complex (DVC), an integrative centre of autonomic functions located in the caudal brainstem, is one of these structures. Leptin, by acting through the DVC, affects autonomic and neuroendocrine functions, such as control of food intake and gastric motility. In the present study, we observed Ob-R labelling within the DVC in cells that correspond to neuronal cell bodies. We showed for the first time Ob-R expression in a subpopulation of glial fibrillary acid protein positive cells located at the border between the area postrema and the nucleus tractus solitarius (NTS). These glial cells exhibit an atypical morphology consisting of unbranched processes that radiate rostro-caudally from the fourth ventricle wall. In vitro, the glial cells exhibited both long and short Ob-R expression with a preferential expression of the Ob-Ra and-f isoforms. Interestingly, using i.v and i.c.v. injection of the fluorescent tracer hydroxystilbamidine, we provided evidence that these cells may constitute a diffusion barrier which might regulate entry of molecules into the NTS. Finally, modulation of energy status, by acute or chronic reduction of food intake, modulated especially the short Ob-R isoforms in the DVC. In the light of these results, we hypothesise that Ob-R positive glial cells of the DVC participate in the transport of leptin into the brainstem and thus contribute to regulation of energy homeostasis.

mPGES-1 knock-out mice are resistant to cancer-induced anorexia despite the absence of central mPGES-1 up-regulation in wild-type anorexic mice

Anorexia-cachexia syndrome is a very common symptom observed in individuals affected by chronic inflammatory diseases. The present study was designed to address the possible involvement of the inducible microsomal prostaglandin E synthase-1 (mPGES-1) in the hypopaghia observed during these pathological states. To this end, we used a model of cancer-induced anorexia and we report here that despite the absence of up-regulation of the mPGES-1 enzyme within the brain during anorexia-cachexia syndrome, mPGES-1 knock-out mice exhibit resistance to tumor-induced anorexia and maintain their body mass.

c-Fos immunoreactivity induced by intraperitoneal LPS administration is reduced in the brain of mice lacking the microsomal prostaglandin E synthase-1 (mPGES-1)

The aim of the present study was to investigate the impact of the deletion of the microsomal prostaglandin E synthase-1 (mPGES-1) gene on lipopolysaccharide (LPS)-induced neuronal activation in central nervous structures. The mPGES-1 catalyses the conversion of COX-derived PGH(2) to PGE(2) and has been described as a regulated enzyme whose expression is stimulated by proinflammatory agents. Using the immediate-early gene c-fos as a marker of neuronal activation, we determined whether deletion of the mPGES-1 gene altered the neuronal activation induced by LPS in structures classically recognized as immunosensitive regions. No significant difference in the c-Fos immunostaining was observed in the brain of saline-treated mPGES-1+/+, mPGES-1+/- and mPGES-1-/- mice. However, we observed that LPS-induced neuronal activation was reduced in most of the centres known as immunosensitive nuclei in mPGES-1-/- mice compared with heterozygous and wild-type mice. The decrease in the number of c-Fos positive nuclei occurred particularly in the caudal ventrolateral medulla, the medial, intermediate and central parts of the nucleus tractus solitarius, area postrema, parabrachial nucleus, locus coeruleus, paraventricular nucleus of the hypothalamus, ventromedial preoptic area, central amygdala, bed nucleus of the stria terminalis and to a lesser extent in the ventrolateral part of the nucleus tractus solitarius and rostral ventrolateral medulla. These results suggest that the mPGES-1 enzyme is strongly needed to provide sufficient PGE(2) production required to stimulate immunosensitive brain regions and they are discussed with regard to the recent works reporting impaired sickness behavior in mPGES-1-/- mice.

Neurogenesis and neural stem cells in the dorsal vagal complex of adult rat brain: New vistas about autonomic regulations—a review

The dorsal vagal complex (DVC) of the brainstem is the major reflex center of autonomic nervous system. Several neuroplasticity effectors have been identified in the DVC of adult rat, such as PSA-NCAM, GAP-43, BDNF and its receptor TrkB; moreover, acute vagal stimulation was found to induce c-fos and to down-regulate western-blot-assayed tissular concentration of PSA-NCAM. Adult neurogenesis was first shown in rat DVC by BrdU incorporation combined with phenotypic labelling in situ; new neurons are generated in equal proportions with new astrocytes and at a lower rate than in olfactory bulb or hippocampus. Intrinsic proliferative cells were then detected within the DVC of adult rat by means of Ki-67 immunohistochemistry and western-blot of D-cyclins. The presence of neural stem cells within DVC was directly demonstrated by applying the in vitro neurosphere assay on microdissected adult DVC explants; DVC-derived neurospheres display lower proliferation rate and neurogenic potential than forebrain ones. Vagotomy in adult promotes massive and transient increase of neurogenic and microglial proliferations within DVC, the kinetics and location of which were analyzed by Ki-67 immunohistochemistry and cyclin D western blot. These mechanisms shed light on so far unknown plasticity potential in DVC, which brings novel cues about physiological adaptations of autonomic reflexes in adult mammals.

Involvement of central microsomal prostaglandin E synthase-1 in IL-1beta-induced anorexia

In response to infection or inflammation, individuals develop a set of symptoms referred to as sickness behavior, which includes a decrease in food intake. The characterization of the molecular mechanisms underlying this hypophagia remains critical, because chronic anorexia may represent a significant health risk. Prostaglandins (PGs) constitute an important inflammatory mediator family whose levels increase in the brain during inflammatory states, and their involvement in inflammatory-induced anorexia has been proposed. The microsomal PGE synthase (mPGES)-1 enzyme is involved in the last step of PGE2 biosynthesis, and its expression is stimulated by proinflammatory agents. The present study attempted to determine whether an upregulation of mPGES-1 gene expression may account for the immune-induced anorexic behavior. We focused our study on mPGES-1 expression in the hypothalamus and dorsal vagal complex, two structures strongly activated during peripheral inflammation and involved in the regulation of food intake. We showed that mPGES-1 gene expression was robustly upregulated in these structures after intraperitoneal and intracerebroventricular injections of anorexigenic doses of IL-1beta. This increase was correlated with the onset of anorexia. The concomitant reduction in food intake and central mPGES-1 gene upregulation led us to test the feeding behavior of mice lacking mPGES-1 during inflammation. Interestingly, IL-1beta failed to decrease food intake in mPGES-1(-/-) mice, although these animals developed anorexia in response to a PGE2 injection. Taken together, our results demonstrate that mPGES-1, which is strongly upregulated during inflammation in central structures involved in feeding control, is essential for immune anorexic behavior and thus may constitute a potential therapeutic target.

Characterization of neural stem cells in the dorsal vagal complex of adult rat by in vivo proliferation labeling and in vitro neurosphere assay

The dorsal vagal complex, located in the brainstem, is the major integrative center of the autonomic nervous system. By combining in vivo bromodeoxyuridine incorporation and phenotypic immunolabeling, we have previously reported that neurogenesis occurs in the adult rat dorsal vagal complex [Bauer S, Hay M, Amilhon B, Jean A, Moyse E (2005) In vivo neurogenesis in the dorsal vagal complex of the adult rat brainstem. Neuroscience 130:75-90.]. In the present study we asked whether adult dorsal vagal complex contains proliferative and/or neural stem cells. Using Ki-67 immunolabeling and cyclin D1 Western blot, we showed intrinsic cell proliferation in the dorsal vagal complex and its stimulation by vagotomy. Detailed time-course analysis revealed that vagotomy-induced proliferation in the dorsal vagal complex peaked three days after lesion. In order to directly assess the presence of intrinsic stem cells, primary cell cultures from adult rat dorsal vagal complex were performed in the presence of epidermal growth factor and basic fibroblast growth factor (neurosphere assay). A discrete subpopulation of dorsal vagal complex cells proliferated as neurospheres, self-renewed when passaged, and differentiated into neurons, astrocytes and oligodendrocytes. Proliferation and neuron-differentiating potentials of dorsal vagal complex neurospheres were both lower than those of subventricular zone neurospheres from the same rats. The relationship between in vitro neurosphere-forming cells of dorsal vagal complex and in vivo dorsal vagal complex neurogenesis is discussed and remains to be directly addressed. The present data demonstrate the occurrence of neural stem cells in the dorsal vagal complex of adult rat brain.

In vivo neurogenesis in the dorsal vagal complex of the adult rat brainstem

The dorsal vagal complex (DVC) encompasses the nucleus tractus solitarii (NTS), the dorsal motor nucleus of the vagus nerve (DMX) and the area postrema (AP), that altogether provide the major integrative center for the mammalian autonomic nervous system. The adult rat DVC has been reported to contain afferent-dependent concentration of the plasticity-promoting polysialylated form of neural cell adhesion molecule [J Neurosci 21 (2001) 4721; Eur J Neurosci 14 (2001) 1194]. This prompted us to assess the occurrence of neurogenesis in the DVC of adult rats. Cumulative in vivo labeling of cell proliferation with i.p. bromodeoxyuridine (BrdU) injections was combined with phenotypic markers and confocal microscopy on serial brainstem sections throughout the DVC extent. In basal condition, sparse BrdU+ nuclei were selectively detected in the DVC according to a discrete and reproducible pattern. Some of them were found to colocalize with the neuronal markers doublecortin, HuC/D, or neuronal-specific antigen (NeuN), demonstrating that neurogenesis does occur within the DVC of adult rat. In the NTS, 10% of the BrdU+ nuclei were also NeuN+. A comparable proportion of astrogliogenesis was found in the DVC. Nestin immunohistochemistry yielded a highly specific labeling pattern at the border between AP and NTS. These data may relate to the neural stem cells that have been reported in the floor of the IVth ventricle [J Neurosci 16 (1996) 7599]. In order to assess a possible modulation of neurogenesis by afferent input in vivo, unilateral vagotomy was performed prior to cumulative BrdU treatment. Such DVC deafferentation triggered a large increase of BrdU incorporation in the ipsilateral DVC, which was associated with microglial proliferation in the DMX and with increased genesis of neurons and astrocytes in the NTS. These findings establish DVC as a novel model of adult neurogenesis that is reactive to deafferentation.

Effects of Er:YAG and Nd:YAP laser irradiation on the surface roughness and free surface energy of enamel and dentin: an in vitro study

Sixty-seven extracted molars were selected (134 samples). Dentin and enamel samples were prepared by buccal and lingual surface sectioning to expose a planar enamel or dentin surface. For the roughness study, 80 samples were randomly assigned to eight groups. Enamel and dentin surfaces were etched with a 37% phosphoric acid solution, irradiated with an Er:YAG laser or irradiated with a Nd:YAP laser. Samples were then observed in SEM using BSE. For the free-surface energy study, 54 samples received the same treatment as above. Two contact angle measurements were made on each surface using a goniometer. Data were analyzed by a non-parametric statistical test. Morphological changes on enamel and dentin were greater with acid-etch and Er:YAG laser than with Nd:YAP laser. Free surface energy was significantly greater with acid-etch or Er:YAG laser than with Nd:YAP laser (p < 0.001).

Microleakage of class V composite restorations following Er:YAG and Nd:YAP laser irradiation compared to acid-etch: an In vitro study

This study compared microleakage at enamel/composite and dentine/composite interfaces following Er:YAG laser, Nd:YAP laser, or acid-etch preparation. Class V cavities produced on the lingual and buccal surfaces of 20 extracted carie- and restoration-free human teeth were randomly assigned to four groups of 10 cavities. Teeth were treated with 37% phosphoric acid and primer (group 1), irradiated with an Er:YAG laser (group 2) or an Nd:YAP laser (group 3), or served as controls (group 4). The specimens were restored with Scotchbond Multipurpose/Z100 (3M), stored in physiological solution at 37 degrees C for 7 days, thermocycled 500 times between 5 degrees C and 55 degrees C, placed in a 0.5% solution of basic fuchsin for 48 h, embedded in resin, and sectioned. Microleakage was assessed according to the depth of dye penetration along the restorative composite. The results showed that irradiation with Er:YAG and Nd:YAP lasers did not produce a good seal. Mean microleakage was greater than with acid-etch and statistically comparable to that of control cavities (Kruskal-Wallis test).

Dual effects of NMDA receptor activation on polysialylated neural cell adhesion molecule expression during brainstem postnatal development

Here we show a dual role of N-methyl-d-aspartate receptor (NMDAR) activation in controlling polysialylated neural cell adhesion molecule (PSA-NCAM) dynamic expression in the dorsal vagal complex (DVC), a gateway for many primary afferent fibres. In this structure the overall expression of PSA-NCAM decreases during the first 2 weeks after birth to persist only at synapses in the adult. Electrical stimulation of the vagal afferents causes a rapid increase of PSA-NCAM expression both in vivo and in acute slices before postnatal day (P) 14 whereas a similar stimulation induces a decrease after P15. Inhibition of NMDAR activity in vitro completely prevented these changes. These regulations depend on calmodulin activation and cGMP production at all stages. By contrast, blockade of neuronal nitric oxide synthase (nNOS) prevented these changes only after P10 in agreement with its late expression in the DVC. The pivotal role of NMDAR is also supported by the observation that chronic blockade induces a dramatic decrease in PSA-NCAM expression.

NMDA receptor and nitric oxide synthase activation regulate polysialylated neural cell adhesion molecule expression in adult brainstem synapses

Here we report that synapses in the adult dorsal vagal complex, a gateway for many primary afferent fibers, express a high level of the polysialylated neural cell adhesion molecule (PSA-NCAM). We show that electrical stimulation of the vagal afferents causes a rapid decrease of PSA-NCAM expression both in vivo and in acute slices. Inhibition of NMDA receptor activity completely prevented the decrease. Blockade of calmodulin activation, neuronal nitric oxide (NO) synthase, or soluble guanylyl cyclase and chelation of extracellular NO mimicked this inhibition. Our data provide a mechanistic framework for understanding how activity-linked stimulation of the NMDA-NO-cGMP pathway induces rapid changes in PSA-NCAM expression, which may be associated with long-term depression.

Brain stem control of swallowing: neuronal network and cellular mechanisms

Swallowing movements are produced by a central pattern generator located in the medulla oblongata. It has been established on the basis of microelectrode recordings that the swallowing network includes two main groups of neurons. One group is located within the dorsal medulla and contains the generator neurons involved in triggering, shaping, and timing the sequential or rhythmic swallowing pattern. Interestingly, these generator neurons are situated within a primary sensory relay, that is, the nucleus tractus solitarii. The second group is located in the ventrolateral medulla and contains switching neurons, which distribute the swallowing drive to the various pools of motoneurons involved in swallowing. This review focuses on the brain stem mechanisms underlying the generation of sequential and rhythmic swallowing movements. It analyzes the neuronal circuitry, the cellular properties of neurons, and the neurotransmitters possibly involved, as well as the peripheral and central inputs which shape the output of the network appropriately so that the swallowing movements correspond to the bolus to be swallowed. The mechanisms possibly involved in pattern generation and the possible flexibility of the swallowing central pattern generator are discussed.

Analgesic and antiinflammatory activities of an extract from Parkia biglobosa used in traditional medicine in the Ivory Coast

In the Ivory coast, Parkia biglobosa (Mimosaceae) is used in traditional medicine as an analgesic drug, especially against dental pain. Of the three extracts obtained from the plant bark, the hexane fraction was studied to determine its analgesic and/or antiinflammatory activities. The results show that this extract possesses a marked analgesic activity when evaluated with the abdominal writhing test in mice, but, like paracetamol, was ineffective with the hot-plate method, a feature suggesting a peripheral mechanism of action. This activity was accompanied by an antiinflammatory effect, somewhat weaker than the analgesic one.

Temperature rise during Er:YAG and Nd:YAP laser ablation of dentin

This in vitro study compared temperature rises during cavity preparation with an Er:YAG laser, Nd:YAP laser, and a high-speed handpiece. Eighteen teeth were sectioned longitudinally and divided into six groups: group 1 was treated with a carbide bur on a high-speed dental handpiece; group 2 was treated with an Er:YAG laser with an energy of 140 mJ, a pulse repetition rate of 4 Hz; and group 3 was treated with an Nd:YAP laser with an energy of 240 mJ, a pulse repetition rate of 10 Hz. In these groups no water cooling was used. Groups 4 to 6 were treated in the same way, but with water spray. Temperature increases were measured at different dentin thicknesses by a microthermocouple attached to the inner side of the pulp chamber. Water cooling was essential to reduce temperature effects in all groups. Nd:YAP laser induced significantly higher temperature rises than Er:YAG or handpiece. Temperature response to the Er:YAG laser and the handpiece seemed to be similar.

Ultrastructural properties of laser-irradiated and heat-treated dentin

Previous studies using scanning electron microscopy and infrared absorption spectroscopy reported that laser irradiation causes compositional changes in enamel. The purpose of this study was to evaluate the ultrastructural and compositional changes in dentin caused by irradiation with a short-pulse laser (Q-switched Nd:YAG). The irradiated and non-irradiated areas of the lased dentin samples were investigated by scanning (SEM) and transmission electron microscopy (TEM), micro-micro electron diffraction, and electron microprobe analysis of dispersive energy (EDX). Heat-treated dentin was similarly investigated. This study demonstrated that laser irradiation resulted in the recrystallization of dentin apatite and in the formation of additional calcium phosphate phases consisting of magnesium-substituted beta-tricalcium phosphate, beta-TCMP, beta-(Ca,Mg)3(PO4)2, and tetracalcium phosphate, TetCP, Ca4(PO4)O. TEM analyses of the modified and unmodified zones of the irradiated areas showed two types of crystal populations: much larger crystals from the modified zone and crystals with size and morphology similar to those of dentin apatite in the unmodified zone. The morphology of crystals in the modified zones in the irradiated dentin resembled those of dentin sintered at 800 or 950 degrees C. In the irradiated areas (modified and unmodified zones), the Ca/P ratio was lower compared with that in the non-irradiated dentin. The Mg/Ca ratio in the modified zones was higher than that in the unmodified zones and in the non-irradiated dentin. In sintered dentin, the Mg/Ca ratio increased as a function of sintering temperature. The ultrastructural and compositional changes observed in laser-irradiated dentin may be attributed to high temperature and high pressure induced by microplasma during laser irradiation. These changes may alter the solubility of the irradiated dentin, making it less susceptible to acid dissolution or to the caries process.

Scanning electron microscopic analysis of diseased and healthy dental hard tissues after Er:YAG laser irradiation: in vitro study

The aim of this study was to treat carious lesions, sound dentin, and enamel either with conventional methods or with an Er:YAG laser and to compare the results. Thirty freshly extracted carious human teeth were divided into two groups. In the first group, lesions were treated with burs in a dental handpiece; in the second group, we used the Er:YAG laser with parameters recommended by the manufacturer (Kavo). After treatment, the teeth were prepared for scanning electron microscopic observation. On laser-treated teeth, scaly, flaky, rough surfaces were seen: surfaces were clean with several morphological reliefs that may enhance bonding resin restoration. The Er:YAG laser beam can ablate carious dentin with an energy level of 250 mJ at 2 Hz. Sound dentin can be cut at 300 mJ and 2 Hz; for enamel, 350 mJ and 3 Hz are required. The Er:YAG laser seems to be effective in the treatment of carious lesions and in cavity preparation in vitro.

[Deglutition: physiologic and neurophysiologic aspects]

Swallowing is a complex motor sequence involving the coordinated contraction of many muscles of the buccopharyngeal cavity, the larynx and the oesophagus. Most of the muscles are striated except those of the distal oesophagus which, in human and some other species, are of the smooth type. During swallowing, usually divided into a buccopharyngeal and an oesophageal stage (peristalsis), the sequential activity of the muscles results from motor orders programmed by a rhombencephalic swallowing centre and conveyed to the periphery by efferent fibres belonging to various pairs of cranial nerves (Vth, VIIth, Xth, XIIth). Apart from the motor nuclei of the cranial nerves, the swallowing centre contains an interneurone network responsible for the programming of deglutition. During swallowing, these interneurones (INs) exhibit a sequential activity quite parallel to that of muscles, and persisting in the absence of sensory feedback. The "swallowing INs" are located in two medullary regions: (1) a dorsal region including the nucleus of the solitary tract and the adjacent reticular formation, (2) a ventral region corresponding to the reticular formation surrounding the nucleus ambiguus. The dorsal INs are involved in the initiation and the programming of swallowing. The ventral INs receive their swallowing input from the dorsal neurones and are probably switching neurones that distribute the swallowing excitation to the various pools of motoneurones. The swallowing program can be triggered by inputs originating from either the peripheral reflexogenic areas or the supramedullary structures (cerebral cortex, basal ganglia and hypothalamus). Under physiological circumstances swallowing program is continuously modified by peripheral afferents (expecially muscular) that adjust the force and the timming of contractions to the size of the swallowed bolus. In addition, an important operating feature of the programming network consists of a functionnal polarization so that the activity of proximal portions of the swallowing tract inhibits that of distal portions. This polarization implies the existence of inhibitory connections between interneurones, that could be responsible for the series of delays typical fo swallowing contractile sequence, by generating delayed desinhibitions followed by post inhibitory excitations. Lastly, the sensitive messages that trigger and adjust the swallowing program are at the same time conveyed to higher nervous structures allowing the so called "voluntary" swallow and the integration of swallowing in the ingestive behavior. Disruption of this central loop is likely the source of swallowing disorders (dysphagia) following lesion of cortical or subcortical structures.

Immunohistochemical detection of glutamate in rat vagal sensory neurons

Vagal primary afferent neurons have their cell bodies located in the nodose (inferior) and jugular (superior) vagal ganglia and send terminals into the nucleus tractus solitarii (NTS) which lies in the dorsomedial medulla. The presence of glutamate (Glu)-containing neurons in the rat nodose ganglion was investigated using immunohistochemistry. Glu-immunoreactivity on nodose sections was found in neuronal perikarya and nerve fibers, but not in non-neuronal elements such as Schwann cells and satellite cells. Both immunoreactive and non-immunoreactive ganglion cells were observed. The immunoreactive ganglion cells amounted to about 60% of the nodose population. No specific intraganglionic localization was observed for the non-immunoreactive cells. Immunoreactive perikarya were slightly smaller than the non-immunoreactive ones, but no relationship was found between size and staining intensities of immunoreactive neurons. The present data indicate that immunodetectable Glu is present in a large population of vagal afferent neurons. They therefore add to a growing body of evidence suggesting that Glu may be the main neurotransmitter released by vagal afferent terminals within the nucleus tractus solitarii.

Scanning electron microscopic evaluation of the effects of an air-abrasive system on dental implants: a comparative in vitro study between machined and plasma-sprayed titanium surfaces

An in vitro comparative study was conducted in order to evaluate the effects of an air-abrasive system on dental implant surfaces. Eight new titanium dental implants, four standard machined implants (machined group), and four standard plasma-sprayed implants (plasma-sprayed group) were selected for investigation. Both neck and body surfaces of the implants were analyzed. Each pair of implants in each group was treated as follows: the spray of the air-abrasive unit was applied to each area for 5 seconds on the first implant and 15 seconds on the second implant. A total of 24 areas were observed: 16 test implants and 8 controls. Scanning electron photomicrographs were analyzed by 3 examiners using a category rating scale (kappa = 0.594). The images were also computerized for texture analysis. The results indicate that a single air-powder abrasive treatment of the dental implants selected for this study modified their exposed surfaces. After treatment, the threaded neck surface of a machined group implant was least affected, whereas the body was the most altered. In the plasma-sprayed group, comparisons between implant surfaces showed little change. In the machined group, more change was observed in both neck and body areas. In all specimens, a 5-second exposure to the air-powder abrasive did not induce deep changes in the surfaces. A 15-second exposure modified all the specimen surfaces. Further studies are needed to evaluate the effect of these changes on the biological osseointegration process.

Fourier-transform infrared spectroscopy study of an organic-mineral composite for bone and dental substitute materials

A new injectable biomaterial for bone and dental surgery is a composite consisting of a polymer as a matrix and bioactive calcium phosphate (CaP) ceramics as fillers. The stability of the polymer is essential in the production of a ready-to-use injectable sterilized biomaterial. The purpose of this study was to detect possible polymer degradation which may have been caused by the interaction with the fillers using Fourier transform infrared spectroscopy. Composites containing CaP fillers (biphasic calcium phosphate, hydroxyapatite and peroxidized hydroxyapatite) and polymer (hydroxypropyl methyl cellulose) were prepared. To investigate the properties of the polymer, the inorganic and organic phases of the composite were separated using several extraction methods. The difficulty in separating the organic (polymer) from the mineral (CaP fillers) phases in the composite investigated in this study suggested the presence of strong interactions between the two phases. Spectra of extracted polymers showed new absorption bands of low intensities and indications that some chemical modifications of the original polymers have occurred. Results also indicated that the filler composition has an effect on the integrity of the polymer.

Postnatal ontogeny of glutamate receptors in the rat nucleus tractus solitarii and ventrolateral medulla

The nucleus tractus solitarii and the ventrolateral medulla are two brainstem regions involved in regulation of autonomic functions. Glutamate (Glu) receptors localized within these two regions play a key role in neural control of swallowing and breathing and in blood pressure regulation. In the present study, postnatal changes in global [3H]Glu binding and in [3H]Glu binding to N-methyl-D-aspartate (NMDA) receptors were analyzed in the nucleus tractus solitarii and the ventrolateral medulla using in vitro receptor autoradiography. Similar results were obtained in both regions. When expressed as density values (fmol/mg tissue), both global and NMDA-sensitive Glu binding increased by approximately 50-70% between birth and postnatal day 9 (P9) and then decreased until P30. When expressed as binding per nucleus (i.e., after correction for tissue growth), global Glu binding still increased between birth and P9 and decreased between P9 and P30 whereas NMDA-sensitive binding increased until P9 and remained stable thereafter. Saturation studies showed a postnatal increase in Glu receptor number per nucleus, which occurred mainly between birth and P9, and a decrease in Glu receptor affinity between P9 and adulthood. These results indicate that dramatic changes in glutamatergic neurotransmission occur in the nucleus tractus solitarii and the ventrolateral medulla during the first month of postnatal life. They suggest that both neonates and young animals may not be fully mature as regard to central regulation of autonomic functions.

Developmental study of N-methyl-D-aspartate-induced firing activity and whole-cell currents in nucleus tractus solitarii neurons

Whole-cell recordings of rat nucleus tractus solitarii (NTS) neurons were performed on a slice preparation. We investigated possible postnatal changes in firing activities and currents induced by N-methyl-D-aspartate (NMDA) application. A total of 42 neurons were selected and fell into the following age groups: 0-5 days (n = 15), 10-15 days (n = 9) and 30-60 days (adult, n = 18). During this period, input resistance and spike duration decreased by approximately 40%. At all ages, bath application of NMDA elicited a bursting firing activity when the membrane potential was held between -60 and -75 mV. However, in the youngest cells the rhythmic bursting activity was irregular and was characterized by a progressive firing inactivation during a burst. In a tetrodotoxin-containing saline, NMDA-induced oscillations of membrane potential were retained in all age groups. The membrane current-voltage relationship of the NMDA-induced inward current (INMDA) was characterized by a region of negative slope conductance which was similar in all age groups. Thus the voltage-dependent block of INMDA is present in NTS neurons from birth, allowing NTS neurons to display membrane potential oscillations. However, postnatal maturation of repolarizing conductances, as suggested by changes in spike characteristics, could render the oscillatory activity more stable than at birth.

Digital image ratio: a new radiographic method for quantifying changes in alveolar bone. Part II: Clinical application

As reported in a previous paper (1) we have developed a new technique, Digital Image Ratio (DIR), which theoretically avoids some of the drawbacks of quantitative digital substraction radiography. DIR allows the direct computation and visualization of bone-mass-ratio changes. This second paper describes the use of DIR analysis to examine 20 sites in 8 patients undergoing regenerative periodontal therapy. Standardized reproducible radiographs of these 20 sites were taken before and 12 months after surgery. Ten experimental sites were treated with bone graft substitutes (natural coral or natural coral+collagen), and 10 control sites by debridement alone. None of the experimental sites had a density ratio below 1, where 1 indicates no change. The error was +/- 0.07 (0.93-1.07). The experimental sites showed an 18% mean increase in bone density (1.18), which increased to 23% (1.23) for sites filled with natural coral alone. All the control sites had values close to 1.00 (1.00 +/- 0.07) except for 3 sites, which showed a 9-15% loss of bone density. It is thus possible to compare and quantify the changes in experimental and control sites in the same patient using the percentage gain or loss of bone density. This demonstrates that DIR is suitable for clinical applications, and can be used in clinical analysis when bone changes are expected.

Identification of CYP2B14P and CYP2B16P, two apparent pseudogenes in the rat cytochrome P450 2B (CYP2B) subfamily

Cytochrome P450 2B3 (CYP2B3) is a member of the CYP2B subfamily and is present constitutively in rat liver. During cloning of the CYP2B3 gene, several variant genomic inserts were isolated, exoncontaining fragments of which were identified by hybridizing to CYP2B3 cDNA or exonic probes. Nucleotide sequence analysis of one set of variant inserts showed them to carry exon 1 and the 5'-flanking region of a gene designated CYP2B14P. The last codon of CYP2B14P exon 1 is a TAG translation stop codon, and thus CYP2B14P is a pseudogene. Three other inserts covering 34 kb of genomic sequence together carried 9 exons and the 5'-and 3'-flanking regions of the gene designated CYP2B16P. The 5'-splice site of CYP2B16P intron 1 is inactivated by the replacement of G by T in the normally invariant GT dinucleotide. Thus, CYP2B16P also has the characteristics of a pseudogene. The identification of CYP2B14P and CYP2B16P brings to at least seven the number of genes or pseudogenes shown by nucleotide sequence analysis to belong to the rat CYP2B subfamily.

In vitro models to study wound healing fibroblasts

Phenotypic and contractile properties of human fibroblasts from dermis and from an experimental wound model were studied in vitro. When cultured in monolayer, dermal fibroblasts had an elongated spindle shape, were small in diameter and grew at a high rate. Wound fibroblasts grew slowly and were large, star shaped and had cytoplasmic stress fibres. Smooth muscle alpha actin was detected in 10 percent of dermal cells, whereas 20-80 per cent of wound fibroblasts contained this protein in their cytoplasm. The contractile property of cells was evaluated using a three-dimensional cell culture model. Our results show that wound fibroblasts contract collagen gels during the first days more strongly than dermal fibroblasts. These results show that, in vitro, wound fibroblasts have greater contractile capacity than dermal cells. The significant proportion of wound fibroblasts containing alpha-smooth muscle actin suggests that alpha-smooth muscle actin ratio may be related to wound contraction.

Digital image ratio: a new radiographic method for quantifying changes in alveolar bone. Part 1: Theory and methodology

A new world, digital image ratio (DIR), has been developed for directly measuring changes in alveolar bone. The image on the computer monitor represents the relative mass change between two radiographs. Fourier filtering is used to reduce noise artefacts. This method is validated through an experiment with a step wedge. DIR needs only a preliminary calibration of the experimental conditions of operation and avoids tedious calibrations for each measurement as in the case of digital image substraction. Low-voltage X-ray techniques are suggested for long-term quantitative studies of patients to minimize irradiation doses.

Synaptic organization of the interstitial subdivision of the nucleus tractus solitarii and of its laryngeal afferents in the rat

The nucleus tractus solitarii, the first central relay for gustatory and a variety of visceral afferents, is also an integrative center for numerous functions. Its interstitial subdivision is involved in swallowing and respiratory reflexes. The ultrastructural characteristics of this subdivision and of its laryngeal afferents were investigated in adult rat by a serial-section study and by application of wheat germ agglutinin-horseradish peroxidase conjugate to the peripheral afferent fibers. The interstitial subnucleus contained scattered small neuronal cell bodies with such ultrastructural features as a large nucleus with deep indentations and an organelle-poor cytoplasm. On the basis of their size and vesicular content, the axon terminals were classified into three categories. Group I and group II terminals were small or large, respectively, and contained mainly small, round, and clear synaptic vesicles. Group III terminals were also small but contained small, pleomorphic, and clear vesicles. Axodendritic synapses were the most numerous. They were either asymmetrical, comprised of group I and II terminals, or symmetrical, comprised of group III terminals. More than 50% were part of complex synaptic arrangements in the form of rosettes or glomeruli. Axosomatic contacts involved both group I and group III terminals and were always symmetrical. A high frequency of axoaxonic synapses was found. They were symmetrical, comprised of group III terminals on group I or II terminals. Different types of symmetrical synaptic contacts made by dendrites were also found. This study indicates also that the ipsilateral interstitial subdivision constitutes the preferential site of termination for superior laryngeal afferents. The labeled axon terminals belonged exclusively to groups I and II and were involved in both axodendritic and axoaxonic synapses. Some of the axodendritic synapses were part of rosettes or glomeruli. All these synaptic arrangements may be considered a morphological substrate for important processing of afferent information in the nucleus tractus solitarii. They may account for some of the integrative functions of the interstitial subnucleus such as physiological processes triggered from the superior laryngeal nerve.

Postnatal changes in glutamate binding in the lower medulla of the rat

Changes in [3H]glutamate (Glu) binding occurring in the lower medulla of the rat between birth (P0) and adulthood (P72) were investigated on cryostat sections using in vitro receptor autoradiography. Densitometric measurements were performed in both autonomic (nucleus tractus solitarii, dorsal motor nucleus of the vagus nerve, ventrolateral medulla) and non-autonomic (inferior olive, spinal trigeminal nucleus) medullary regions. In all these areas, binding densities peaked at P9 and then gradually declined. Values close to those measured in adult animals were reached by P23-P30. These data indicate that glutamatergic neurotransmission within the lower medulla undergoes developmental changes during the early postnatal period. They thereby suggest that the neural circuits essential in organizing autonomic functions are still immature at birth.

Rat liver cytochrome P450 2B3: structure of the CYP2B3 gene and immunological identification of a constitutive P450 2B3-like protein in rat liver

The cytochrome P450 2B subfamily in the rat contains an estimated eight to eleven members at the genomic level. Synthesis in the liver of the prototypic forms P450 2B1 and P450 2B2 is dramatically induced by phenobarbital. The 1.9-kb mRNA for P450 2B3, a third member of the P450 2B subfamily, is constitutively present in rat liver but is not inducible by phenobarbital. We have now cloned and sequenced exonic sequences corresponding to the entire 2B3 mRNA and determined their exon-intron structure, which is identical to that of CYP2B1/CYP2B2 and other CYP2B genes. A putative CYP2B3 transcription start site was identified and CYP2B3 5'- and 3'-flanking sequences were compared to those of CYP2B1 and CYP2B2. CYP2B3, like CYP2B1 and CYP2B2, has a modified TATA box preceding the transcription start site and lacks the canonical polyadenylation signal preceding the poly(A) site. A 2B3 expression vector, pMT2-2B3, directed the synthesis in COS-1 cells of an approximately 50-kD protein detectable on Western blots with a polyclonal antibody and with one of four monoclonal antibodies raised against 2B1 but not with a polyclonal antibody raised against P450 PB6. The 2B3 protein migrated with a slightly higher electrophoretic mobility than 2B1 and comigrated with a protein detected by anti-2B1 antibodies in liver microsomes from untreated rats. The results indicate that a 2B3-like protein is present in rat liver and that it is distinct from P450 PB6 and other known constitutive rat hepatic P450s.

Human wound healing fibroblasts have greater contractile properties than dermal fibroblasts

Contractile and phenotypic properties of human fibroblasts from healing wounds were compared to those of dermal fibroblasts using in vitro models. Wound fibroblasts were recovered from implants, made of a polyvinyl alcohol sponge threaded into a perforated silicone tube, 12 days after their subcutaneous implantation in human volunteers. Dermal fibroblasts were isolated from the skin of healthy subjects. Two morphologically different fibroblast populations were observed in cells cultured from implants. In order to characterize these fibroblast populations, intracellular alpha-actin expression was studied by immunofluorescence labeling of cells cultured in monolayer. This protein was detected in less than 1% of the dermal fibroblasts. By contrast, 30 to 40% of wound fibroblasts were labeled and contained fiber networks of alpha-actin. These results confirm the presence of myofibroblasts in human wound healing tissues. The contractile property of fibroblasts and myofibroblasts was evaluated using a three-dimensional cell culture model (fibroblast populated collagen gels). Cells were incorporated in a collagen matrix and cultured for 14 days. The surface area of collagen gels was measured every day. Our results show that wound fibroblasts strongly contract collagen gels during the first 24 hr (surface area at 24 hr = 20-55% of initial surface area) in comparison to dermal fibroblasts (surface area at 24 hr = 70-75% of initial surface area). This superior level of contraction was observed until the fifth day of culture.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative effect of calcium hydroxide and hydroxyapatite on the cellular activity of human pulp fibroblasts in vitro

When, in vivo, calcium hydroxide [Ca(OH)2] or hydroxyapatite are used as dental pulp-capping agents, a reparative dentine bridge is observed. New hard tissue is formed directly on the hydroxyapatite, whereas a characteristic necrotic area appears under Ca(OH)2. The differing pulpal reactions to these two capping agents suggest differing cell responses. After isolation and selection of human pulp fibroblasts in vitro, the cells were characterized by their morphology, their high alkaline phosphatase specific activity, and their synthesis of type I and III collagens and fibronectin. They were then incubated in the presence of either hydroxyapatite (1 mg/ml) or Ca(OH)2 (0.8 mg/ml). With Ca(OH)2, the cells exhibited dramatical alterations in morphology, DNA synthesis, alkaline phosphatase activity and protein synthesis, in accordance with the necrosis observed in vivo. With hydroxyapatite, phagocytic activity of pulpal fibroblasts toward hydroxyapatite particles (< 10 microns) was seen. As a consequence, DNA synthesis was affected. This inhibitory effect was not due to cell damage, as demonstrated by increased [3H]-proline and [3H]-leucine incorporation by the cells. There was also an inhibitory effect of hydroxyapatite on alkaline phosphatase activity, suggesting that the pulp fibroblasts were not in a differentiation stage. In conclusion, compared to the effects of Ca(OH)2 on human pulp fibroblasts, these data are consistent with the biocompatibility of hydroxyapatite previously described in vivo and testify to the occurrence of a biological response elicited by this synthetic biomaterial.